Healthcare Provider Details

I. General information

NPI: 1346068632
Provider Name (Legal Business Name): JEFFERY ALLAN NEWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3764 MCNAB AVE
LONG BEACH CA
90808-2216
US

IV. Provider business mailing address

3764 MCNAB AVE
LONG BEACH CA
90808-2216
US

V. Phone/Fax

Practice location:
  • Phone: 510-676-3297
  • Fax:
Mailing address:
  • Phone: 510-676-3297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY35264
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberPSY35264
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPSY35264
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: